Search

Systemic lupus erythematosus (SLE) is an autoimmune disorder with multifactorial etiology involving vital organs like the heart and causing rare complications like cardiac tamponade which are indeed difficult to manage especially in a setting of macrophage activation syndrome (MAS) with flare. A case of 25-year-old female with flare having high.grade fever and breathlessness on exertion to begin with. Subsequently, she developed pericardial effusion leading to cardiac tamponade and was managed with pericardiocentesis. With the rising ferritin levels, raised triglycerides, and cytopenia, she was diagnosed as MAS, along with reactivation of tuberculosis. She was discharged on oral steroids and anti-tubercular therapy with regular follow-up. Clinical suspicion, keeping in mind, the rarest complications such as cardiac tamponade, and timely employability of biochemical tests can help in early diagnosis of MAS and can lead to early therapeutic intervention in SLE patients preventing fatal outcomes.

Kit lot change in clinical biochemistry labs leads to variations in patient results. This study planned to identify variations during 60 reagent lot changes in our laboratory during the period from June 2018 to May 2019.A statistical analysis was performed to identify the difference between patient samples results variations and QC results. The long term drift was analyzed using a regression test.There was a significant difference between the patient and QC results in 16.7% of reagent lot changes. Moreover, the extent of variation in QC results was 3.3%. No long-term drift was seen in three analytes which were studied using regression analysis.Our results showed that, during reagent kit lot change, along with QC material, the patient samples should also be run in order to identify the variation. However, this practice is presently ignored by most of the laboratories. There was no accumulated effect in our laboratory due to reagent kit lot change.Promena setova reagenasa u biohemijskim laboratorijama na klinikama dovodi do varijacija u rezultatima pacijenata. Plan ovog istraživanja je bio da identifikuje varijacije u toku šezdeset promena setova reagenasa u našoj laboratoriji u periodu od juna 2018. godine do maja 2019. godine.Izvršena je statistička analiza kako bi se identifikovala razlika između varijacija u rezultatima pacijenata i rezultata kontrole kvaliteta (QC). Dugoročne promene su analizirane pomoću regresijskih testova.Otkrivena je značajna razlika u rezultatima pacijenata i kontrole kvaliteta u 16,7% promena setova reagenasa. Takođe, opseg varijacije u rezultatima kontrole kvaliteta bio je 3,3%. Nisu pronađene dugoročne promene u tri analita koja su analizirana regresijskim testovima.Naši rezultati ukazuju na to da bi prilikom zamene setova reagenasa, pored materijala za kontrolu kvaliteta, trebalo testirati i uzorke pacijenata kako bi se identifikovale varijacije. Međutim, većina laboratorija ovaj postupak ne primenjuje. Nije pronađen dugoročni uticaj usled nagomilavanja varijacija prilikom promene setova reagenasa u našoj laboratoriji.

The interrelationship between matrix degradation, oxidative stress, inflammation and trace elements can be speculated in COVID-19. The objective of the study was to evaluate the oxidative stress, inflammation and matrix degradation markers and trace elements in COVID-19 positive patients. A group of confirmed severe COVID-19 positive patients (n = 30) along with COVID-19 negative patients (n = 30) with similar symptoms were included. Both group of patients were assessed for oxidative stress markers, inflammatory cytokines, matrix metalloproteinase (MMP)s and their inhibitors along with trace elements in blood. All the data were subjected to univariate as well as multivariate analysis including PCA, PLS-DA, OPLS-DA. Diagnostic accuracy was tested by ROC curve analysis. Further relationship with Neutrophil/ lymphocyte (N/L) ratio was established if any. Increased oxidative stress, inflammation and matrix degradation is evidenced by significant rise in oxidative markers, inflammatory cytokines and MMP9/TIMP-1 ratio. Decreased Cu/Zn ratio is also observed in COVID-19 positive patients. Multivariate analysis identified SOD, Cu/Zn ratio, IL-6 and TOS, as effective discriminant among the two groups of patients. Further, accuracy was confirmed by ROC curves. Neutrophil/ lymphocyte (N/L) ratio, shows significant negative association with SOD (r= -0.75, p 0.005) and Cu/Zn ratio (r = -0.88, p 0.005). These data suggest the attributes of these biomarkers in disease severity. The potential use of these blood-based laboratory markers in disease prognosis seems promising and warrants further attention. Given by the symptoms and severity of the disease, it will be promising to monitor Cu/Zn ratio along with other prognostic indicators.

The current COVID-19 pandemic has not only greatly burdened healthcare system globally but also exposed the medical and paramedical staff to risk of infection. Although the major mode of transmission of this highly infectious disease is via close contact with an infected person i.e., droplet infection due to coughing/sneezing and aerosol generation, few research articles have shown presence of SARS-CoV-2 in blood and serum. This poses a potential risk to health care professionals who are handling these samples. Once the suspected/confirmed case of COVID-19 is admitted in the hospital setting, it requires a battery of clinical chemistry investigations. Laboratory has a vital and indispensable role to play in the management of COVID-19 patients as several biochemical markers are used for prognostication as well as monitoring and guiding treatment in the critical patients. Hence, this evaluation was undertaken to have protocols based on robust recommendations and guidelines to be followed while handling the potentially infective samples in the clinical laboratories in order to ensure safety of the staff. However, these recommendations are based on the limited and rapidly evolving knowledge available at the moment and hence need to be reviewed periodically.

Introduction: Sickle cell trait (SCT) is an independent risk factor for chronic kidney disease (CKD). CKD is a well-established risk factor for progressive cardiovascular dysfunction. Sickle Cell trait has been noted to promote a persistent systemic pro-inflammatory state. This pro-inflammatory state could potentially increase the risk of systemic endothelial dysfunction when accompanied with other cardiotoxic conditions. We aim to investigate cardiovascular outcomes in patients with SCT and CKD, compared to SCT alone. Methods: Patients with CKD were identified in the National Inpatient Sample (NIS) database 2016 using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), and subsequently were divided into two groups, those with and without SCT. Both population sets were paired using 1:1 propensity score matching based on Age, Sex and co-morbidities to address potential confounding factors. Outcomes of interest were overall mortality, rates of stroke, sudden cardiac arrest (SCA) and cardiomyopathy. Results: Mean age of patients with CKD alone was 72.98 ± 13.2 years, while for CKD and SCT 56.68 ± 17.3 years. There was no significant difference between the two group in the rates of stroke (1.3% vs 1.0%; P= 0.125), and SCA (1.0% vs 1.1%; P= 0.841). Overall mortality (5.7% vs 2.2%; P Conclusion: Compared to patients with CKD alone, those with CKD and SCT have a lower risk for overall mortality and cardiomyopathy. Further studies are needed to replicate this finding and look at the possible protective role of SCT in patients with CKD.

Introduction: Healthcare industry is witnessing sharp rise in price in almost all its products and services. Hospital’s inventory management has become increasingly important in the recent past. Organizations process mapping is composed of activities involved in defining what an organizational entity does, who is responsible, to what standard organization process should be completed, and how the success of an organizations process can be determined. Aim and objectives: This study focuses on basic components of supply chain process in the central store to make it more efficient in sales, distribution and storage of drugs. Materials and methods: Data was collected from central stores department for two months through process mapping; Quantitative and observational/ prospective design are used to identify the main supply issues and data analysis. Results: The compliance was found to be 100 % in all the different processes like procurement process, internal quality checks, storage of drugs, ledger maintenance & documentation and maintenance of special drugs except GRN date which was 75.45%, storage of high risk medicine amounting to 81.82%. Conclusion: Innovative design of supply chain has a significant impact on selection of and cooperation with excellent suppliers, improves supply chain efficiency, and encouragement of QM practices. Keywords: Inventory management, Supply chain, Central stores department, Drugs

Introduction: Subclinical hypothyroidism refers to thyroid hormone deficiency in patients who have no apparent clinical features. Both iron deficiency anemia and subclinical hypothyroidism, due to their high prevalence and close interrelation, are significant clinical problems. Aims and Objectives: Association of subclinical hypothyroidism and disordered iron metabolism was studied so that better management of iron deficiency could be advised in these patients. Materials and Methods: 150 newly diagnosed subclinical hypothyroid patients and 150 healthy euthyroid controls were included. Total T3, total T4, TSH, iron, TIBC, transferrin and ferritin were measured. Data was analysed by student‘t’ test and Person’s formula. Results: Mean total T3, total T4, iron, TIBC, transferrin and ferritin values of study group were lower than that of control group (p < 0.05). Mean TSH values of study group was higher than that of control group (p < 0.05). Total T4 and T3 were positively correlated with transferrin (p < 0.05). The patients of subclinical hypothyroidism had altered iron metabolism. Conclusion: Decreased iron profile in subclinical hypothyroidism was significantly high. It was suggestive to regularly investigate iron profile for early detection and its early management in case of subclinical hypothyroidism. Keywords: Subclinical Hypothyroidism, Serum Iron, TIBC, Ferritin, Transferrin

Background Magnesium (Mg++) deficiency can result in life-threatening complications. The incidence of hypomagnesemia, as well as any coexisting hypokalemia and Electrocardiography (ECG) abnormalities, was studied in patients undergoing major gastrointestinal (GI) surgeries. Methods This observational study on 51 consecutive adult Intensive Care Unit (ICU) patients recorded serum Mg++ and serum potassium (K+) levels, and 12 lead ECGs, preoperatively and postoperatively, at 48 h and 72 h. Paired “t” test, Pearson Correlation Coefficient and chi-square test were used to statistically assess the difference, correlation, and association between serum Mg++, serum K+, and abnormal ECGs, respectively. Results Mean values for serum Mg++ were 1.72 mg/dl and 1.71 mg/dl on day 2 and 3 postops, respectively, while for serum K+ it was 4.14 meq/l and 4.02 meq/l. The incidence of postop hypomagnesemia was 52.9% with a 95% confidence interval (39.2–66.2) on Day 2 and 47.1%, with a 95% confidence interval (33.7–60.7) on Day 3. The incidence of coexisting hypokalemia was 33.3% on Day 2 and 29.2% on Day 3. There was no significant difference between pre and postop serum Mg++ and serum K+ values. The incidence of abnormal ECG was 33.3% on Day 2 postop and 28.6% on Day 3 and had a significant association with incidence of hypomagnesemia on Day 2 (P = 0.02). Conclusion Incidence of hypomagnesemia showed no significant difference pre and postoperatively. A significant association was present between the incidence of hypomagnesemia with abnormal ECG on the second postop day, but this was not found significant when compared with cases of hypomagnesemia with coexisting hypokalemia.

Introduction: Cardiovascular diseases are the most prevalent cause of mortality and morbidity in both developed as well as developing countries. Coronary artery disease (CAD) is usually due to atherosclerosis of large and medium sized arteries. Dyslipidemia and hyperglycemia have been found to be the important contributing factors. Aims and objectives: Present study is done to know the pattern of dyslipidemia and blood glucose status as per National Cholesterol Education Program – Adult treatment panel III (NCEP-ATP III) guidelines and American Diabetes Association (ADA) criteria respectively in young doctors and to sensitize the importance of its implication and to take timely preventive measures. Material and methods: This is a retrospective observational study conducted in a tertiary care hospital. The study group comprised of 173 young doctors from all over India, between age 25 to 29 years who reported to lab for routine medical investigations. The study group included 118 males and 55 females. Serum lipid profile and plasma glucose for 173 subjects were analyzed. Results: In our study 71.7% of total study group had impaired range of plasma glucose values and 10.4% had diabetic range plasma glucose.5.78% of total subjects had Triglyceride (TG) level more than 200 mg/dL.11.56% had total cholesterol (TC) level >240 mg/dL. 45.66% of total subjects had Low density lipoprotein cholesterol (LDLc) more than 130 mg/dL. 37.2% of males had high density lipoprotein cholesterol (HDLc) less than 40 mg/dL. 40% of females had HDLc less than 50 mg/dL. Thereby implying that even apparently healthy young medical professionals are at increased risk of metabolic disorders like diabetes and dyslipidemia. Conclusion: This study revealed higher prevalence of hyperglycemia and dyslipidemia in apparently healthy medical professionals suggesting higher risk for metabolic disorders like coronary artery disease and diabetes mellitus. The study indicates the need for physical exercise, change in dietary pattern and regular monitoring of biochemical indicators of metabolic diseases. Keywords: Dyslipidemia, Impaired fasting glucose, young, doctors, diabetes

Introduction: Diabetes mellitus (DM) is a metabolic disorder occurring due to either defect in the secretion of insulin or defect in the action of insulin characterized by hyperglycemia. Hyperglycemia causes oxidative stress due to increased production of mitochondrial Reactive oxygen species (ROS) in T2DM. Ceruloplasmin (Cp) acts as an antioxidant through its ferroxidase activity. There is an association between the raised serum Cp levels and elevated plasma glucose levels in Type-2 Diabetes mellitus (T2DM) patients. Aim and objectives: The aim of this study is to evaluate the correlation between the fasting plasma glucose (FPG), 2hour plasma glucose (2hPG), and serum Cp level in T2DM patients as compared to non diabetics. Materials and methods: 165 cases of T2DM were recruited along with the 40 healthy age and sex matched controls. The blood samples were analyzed for serum Cp and FPG and 2hPG after 75-gram oral glucose. Results: The serum Cp levels of the patient group with T2DM were significantly higher than the control group (p = 0.000). There was a significant positive association between serum Cp level and 2hPG level of the patient population (r = 0.283, p = 0.000), but there was no significant correlation found between serum Cp levels and fasting plasma glucose levels in patients (r = 0.146, p =0.061). Similar findings were seen in the sub group analysis. Conclusion: Our study concludes a significant positive correlation between serum Cp and 2hPG levels in T2DM patients. Hence Cp levels may be considered as a part of the routine diagnostic panel to assess diabetes mellitus. Keywords: Serum Ceruloplasmin, Type-2 Diabetes Mellitus, Fasting plasma glucose, 2hour plasma glucose

Introduction: Patients of Diabetes mellitus type 2 are known to have high levels of BUN and Serum creatinine levels as compared to non-diabetics. There is an association between the raised BUN, serum creatinine levels and poor glycemic controls, subsequently leading to complications like nephropathy in Diabetic patients. Aim and objectives: The aim of this study is to assess the BUN, Serum creatinine levels in relation to fasting plasma glucose (FPG) and 2-hour post plasma glucose (2h-PG) status in diabetic patients as compared to non-diabetics. Materials and methods: 215 cases of Diabetes Mellitus were recruited along with the 100 age and sex matched controls who were healthy and non-diabetic and their blood samples were analyzed for BUN and FPG and 2-h-PG after 75-gram oral glucose in National Accreditation Board for testing and calibration Laboratories (NABL) certified laboratory. Results: In our study we have found that there is a significant association of FPG, 2h-PG, BUN and serum creatinine in diabetic cases as compared to non-diabetic controls. There also exists a significant positive correlation between mean BUN (12.3 ± 5.9mg/dL) and mean FPG (159.72 ± 71.60 mg/dL) and mean 2h-PG (222.76 ± 100.86 mg/dL) levels. Conclusion: BUN and serum creatinine are the markers in diabetes patients to assess the diabetic nephropathy. Serum BUN may be preferred over serum creatinine in assessing early renal impairment due to positive correlation with fasting and post prandial glycemic levels. Keywords: BUN, Nephropathy, FPG, 2h-PG, Diabetic complications.

Introduction: India is presently facing an epidemic of diabetes mellitus and the risks of chronic complications from the disease are associated with the duration of the disease as well as the degree of hyperglycaemia. Diabetic retinopathy is a known microvascular complication of diabetes mellitus and is the most common cause of blindness in the western countries. Apolipoproteins are the protein component of lipoproteins. Apart from acting as structural proteins, they also act as cofactors to various enzymes. Aim: To measure the levels of serum apolipoproteins and glycated haemoglobin in cases of diabetic retinopathy and to assess their association with the stages of diabetic retinopathy. Material and Methods: The 135 diabetic cases [with (110) and without (125) retinopathy] attending the Ophthalmology OPD of this tertiary care hospital were included in the present study. Following retinoscopy, the patients were classified as Non-Proliferative Diabetic Retinopathy (NPDR) (n=75) and Proliferative Diabetic Retinopathy (PDR) (n=35). The controls (n=100) were age and sex matched patients who did not have diabetes. The cases and controls were assessed for HbA1c, total cholesterol, triglycerides, HDL cholesterol, Apo A-I and Apo B-100. Results: The HbA1c was found to be higher in diabetics without retinopathy (7.02%) as compared to controls (5.58%) (p

Background: There is total alteration of various antioxidants in response to the oxidative stress, which is one of the major patho-physiologic hallmarks in chronic obstructive pulmonary disease (COPD) development. This study aims to establish the correlation between different antioxidants in normals and COPD, study the alteration in the correlation due to COPD and smoking as well as the impact of COPD and smoking on antioxidants levels.Methods: Study comprises of 96 normals as group I and 96 COPD patients as group II. The antioxidants albumin (Alb), bilirubin (Bil), uric acid (UA) ceruloplasmin (Cp), glutathione peroxidase (GSHPx), catalase (CAT) and superoxide dismutase 3 (SOD3) were estimated.Results: Significant lower serum Alb, UA, SOD3 and increased serum Cp and GSHPx were found in Group II. Significant correlation was found between Alb and UA (r=0.24); Bil and UA (r=0.26); Alb and CAT (r=0.211) and SOD3 and CAT (r=0.318) in normals. However, these correlations were altered in COPD where Alb correlates with Bil (r=0.235); UA with CAT (r=0.203) and SOD3 with GSHPx (r=-0.27). The correlation between SOD3 and CAT remained unaltered. Similar correlation of UA with Alb and Bil was observed in nonsmoker normals and between SOD3 and CAT in smoker normals. In COPD, no correlation was seen in nonsmokers, while in smokers Alb correlates with Bil (r=0.316) and SOD3 with CAT (r=0.317).Conclusions: These alterations may have clinical ramifications in further understanding the pathogenesis of COPD and developing therapeutic approaches.

High prevalence of diabetes and genetic predisposition to metabolic syndrome among Indians places Indian women at risk to develop gestational diabetes mellitus (GDM) and its complications. Literature defines multiple criteria for GDM. This prospective study compares available diagnostic criteria for GDM in Indian women and their correlation with perinatal morbidity.Nine hundred and forty-eight consecutive voluntary nondiabetic pregnant women were recruited for the study. Seven hundred and twenty-three of these (mean age 23.45 years; 75.7%25 years) who reported for the follow-up were screened for GDM at 24-28 weeks gestation by American College of Obstetrics and Gynaecology (ACOG) guidelines and World Health Organization (WHO) criteria. Glycated haemoglobin (HbA1c) and fasting and two-hours postglucose plasma insulin levels were also analysed. Pregnancy outcome was known for 291 of these. Concordance of risk factors and perinatal complications was analysed with respect to GDM.Prevalence of GDM at 24-28 weeks gestation was found to be 4.8% by WHO criteria, 6.36% by Carpenter and Coustan's criteria, and 3.5% by O'Sullivan's criteria. Prevalence was marginally higher in women of higher age, having past history of abortion or family history of diabetes mellitus (DM) (P0.05). None of these women had HbA1c6%. Relative risk of abnormal delivery (pregnancy outcome) was 1.93, 1.39, and 1.17 in women with GDM by O'Sullivan's, WHO, and Carpenter's criteria, respectively (P0.05). Abnormal deliveries were marginally higher in women with high postglucose load insulin levels. Mean weight of the newborns was essentially the same in GDM and nonGDM women by any of the criteria. One-hour and two-hours postglucose values were more sensitive in diagnosing GDM by O'Sullivan's criteria while fasting plasma glucose value had the poorest specificity with 2.5% of nonGDM women having values above the cut-off. Modifications of these criteria did not im-prove their predictive value for abnormal delivery over that of O'Sullivan's criteria.Prevalence of GDM and abnormal delivery in women35 years of age is low. Therefore, global screening for GDM may not be very useful in women25 years of age unless family history of DM or past history of abortion is present. Existing evidence is inadequate to justify the switchover from O'Sullivan's criteria for diagnosis of GDM.

PURPOSE To report a patient who had concomitant congenital hamartoma of the retinal pigment epithelium and retina and ipsilateral congenital blepharoptosis. METHODS Case report. RESULTS An 11-year-old male presented with left-sided congenital blepharoptosis and combined hamartoma of the retina and retinal pigment epithelium in the ipsilateral eye. The systemic examination was within normal limits. The diagnosis of combined hamartoma was established by typical ophthalmoscopic and optical coherence tomography findings. CONCLUSION Congenital blepharoptosis may be associated with ipsilateral combined hamartoma of the retina and retinal pigment epithelium.

Herein, we report a case of endogenous endophthalmitis caused by Enterococcus casseliflavus. The organism was sensitive to gentamicin, vancomycin and chloramphenicol and resistant to cefazolin, ofloxacin, gatifloxacin and ciprofloxacin. The patient was successfully treated with vitrectomy and sensitivity-based intravitreal vancomycin.

Orbital myocysticercosis is a helminthic infestation with variable clinical presentations. Computed tomography is considered gold standard in orbital imaging. Evaluation of computed tomography films in out-patient departments (OPD) is important in the management of orbital diseases. In this case report, we highlight the use of a smart phone as an aid in OPD for studying computed tomography images in identifying a small cysticercus cyst of the superior rectus muscle, which was invisible on naked eye examination.

Approximately 70 percent of cases occur as a direct complication of intraocular surgery. Such post-operative endophthalmitis may be acute (presenting within 6 weeks of surgery) or chronic. Incidence of acute endophthalmitis following cataract extraction have been reported between 0.072% and 0.13% in various studies.1-4 The most common infecting organisms following cataract extraction are the coagulase-negative Staphylococcus spp., especially S. epidermidis.5,6